Two or Four Dental Implants?

Why if I may ask do you only have 2 implant sizes available. What is the available width buccal lingually? I would always rather have 4 than 2. Better retention dispersal of forces and increase chances for success if 1 fails. More xrays would be helpful. Pan CBCT.

hi, always use more implants for better retention,support for the prosthesis and go for 4/8.5 for all the four if sufficient buccolingual width is available.

Dr. I: For retention of a mandibular overdenture, only two implants in the intraforaminal area are necessary. As part of your informed consent, you are required to give the patient an explanation of the alternatives, which include a bar overdenture, fixed prostheses, etc... An overdenture on two implants gives only retention and the patient will experience the usual troubles related to a conventional denture that is tissue supported. By placing four implants and splinting them with a bar, you can provide an implant supported prosthesis wich is a lot more comfortable to the patient. So the better treatment plan is four implants and an implant supported overdenture, as opposed to two implants and a tissue supported, implant retained overdenture. Good luck!

Just as an aside... Burns D., et. al. Randomized, Prospective, Clinical Evalution of Prosthodontic Modalities for Mandibular Implant Overdenture Treatment. JPD 2011; 106:12-22. They looked at 30 patients, all had four implants placed and all had the chance to wear three different types of prostheses. A bar on four implants, a bar connecting 2 implants and independent ball attachments. Conclusions: "The 4-implant bar treatment provided greater prosthesis retention than the other treatment types in this study, but after experience with all systems, subjects were more satisfied with and preferred the independent implant treatment. All implant over dentures require post insertion maintenance, but there are advantages to free standing implants. Less space required, easier to clean, initial fabrication less involved, relines less involved. It is nice to have options to offer your patients. Sometimes "less is more"

If you are planning an implant retained overdenture then one needs to consider the patient's age. I have used overdentures retained with locator abutments frequently and my preferred option where there is only anterior bone available for implant placement, is to place 3 implants, and I find these generally provide good retention. In older more frail patients, the retention can sometimes be too much for them to easily remove and replace, in which case 2 implants suffice. In younger patients, occasionally more retention is required.Locator abutments are simpler and more economical to use and it is easier to reline dentures with locator abutments than with bars. The bone in the lower jaw is usually of a very dense nature in this reason and stand alone implants work well.The converse applies to the upper jaw where the bone is usually of a poor cancellous nature and splinting of the implants with bars is usually needed I am not happy using full fixed prostheses retained by 4 anterior implants. I believe that second molar occlusion is the norm for good occlusion and to achieve anything like this with 4 anterior implants is impossible.Karl Misch is certainly opposed to cantilevering prostheses off implants due to the stresses involved and I certainly agree with him.

Consider using 4 mini-implants..... easy to place and provides wonderful retention for the denture.... the patient will be ecstatic with the results...

4 definitely. However, you say you have only 2 choices for implants. If you are doing implants you need to have more than 2 sizes available. If you do implants, do it right for the patients. Do not skimp. These x-rays are not diagnostic. Make sure you have better ones before proceeding. Did you talk to the patient about the possibility of jaw fracture? Good luck.

2 implants of proper length & diameter (according to the dimensions of bone) are suficient to retain an overdenture but 3 or 4 would be the best.

Are you having a clearance sale? Either be an implant surgeon or don't . If you can't engage both the superior and inferior cortex of this patients mandible then you have no business tx them. Please dont suggest mini implants. Yes it's an option ,but relatively speaking it's a poor one. Yes they are cheaper, but when I remove them and place bigger ones, it's a lot more expensive. 2-3 or 4 ,it's up to the patient and restorative guy. This patient couldn't clean their teeth before, so why would they change. Make it functional and easy. Dollar for dollar this is the best service we can provide. Bvinci

Dr Schwartz , I saw a patient this am that had four mini's ,placed 3 months ago, by a respected perio doctor, she was ecstatic when I removed two of them with a gloved hand and even more so when she saw the cost to remove the other two and place real implants. I'm not sure what the cost of the fentanyl patch was , that she was wearing. Mini- implants are for all intense and purposes myopic medicine. They are great for temp stabilization and ortho anchorage. Bvinci

I've been looking at X-rays for more than 2 and1/2 decades. What in the he'll are we looking at? Is that an occlusal X-ray ? Dont tell us you are placing old calcitecs , that you found under one of your dental chairs! Keeping it lite, bvinci

I know most get bored with my opinions, but to use words like definitely, one hundred percent, only,really makes little scientific since. All I see is two x-rays of someones deformed humerus for all I know. Just another opinion. Bv

2 regular implants should be minimal. 4 is even better.

Agree with Dr. Boudet. Haderbar on 4.

2 regular implants should be minimal. 4 is even better.

OK, I'll prob be shot for saying this, but... I hope the treating Doc understands that that x-ray image is highly distorted and mis- angled, and prob the least capable view of showing the bone depth available for implants. The vertical height in that film is not close to representing the amount and shape of bone present. I guess those are Genial Tubercles in the v" ... The road signs to the Lingual nerve and all the forbidden territory beyond.

These are two X-rays of the same exact spot. No, I am not a forensic dentist , but why am I having such a difficult time figuring out what I am looking at. I think this is a trick question. I'm not sure you should be treating this patient , if you can't at least sweat the cost of a panaramic and a lateral ceph.. I'm not sure proceeding without a cbct, could be defended in a court of law. Bv

Yes, I did read all the posts above and yes, I am going to repeat some of the information that has already been stated previously - but IMHO it is important. First, you don't get into a car, drive and then decide where you need to go. Placing implants without direction and then designing a denture around them seems like doing the same thing. Sometimes we make things to hard for ourselves by just not having a clear cut goal or objective to work towards. Maybe the first thing on the agenda should be a patient acceptable, functionally designed and esthetic wax try in. It ends up needing to be done anyway - why not do it first. Step two, design the retention and try to plan/place implants to accommodate that design. - Like it or not, CBCT's are going to be the standard of care and quite possibly, they are already. I have used scans and the planning software for about six years and, like others have said, couldn't do without it now. The anatomy and all the densities and dimensions are well defined. I use radio-opaque markers (i.e. a scan appliance) based on the wax setup as a guide for implant placement. The number of implants and type are chosen on the basis of available good bone, proposed appliance design, loading and retention needed (these really need to a known variables at this point.) I will most often use a surgical guide to aid in drilling and placement. I have found that the entire planning and surgical process is dramatically simplified with this approach. - Lastly, having done this for many years, I still find it difficult to prepare parallel (or at least restoratively serviceable) implant sites in the edentulous arch freehand. I also hate the feeling that the mandibular dense bone that I have encountered may be the lingual plate due to some unknown defect/variant. Personally, I do like having the scans and surgical guides to help me in surgery. I like knowing what is there and these surgical aids add some vision and guidance to an otherwise blind drilling procedure. Surgical guides may even be more important in edentulous cases. Keeping osteotomies within bone and correctly oriented is very difficult since we don't have many fixed points of reference to guide us. - Dr. No

To all that use the term "panorex". You do know that company went out of business decades ago, correct? Do you call all soft drinks , coke. Just a suggestion , since we are all scientist, eager to learn and teach, why not use accurate terminology. panoramic X-ray is probably the most appropriate way to describe this view. Bv